title: Conformance to schizophrenia treatment guidelines in North West-Bank, Palestine: focus on antipsychotic dosing and polytherapy.
abstract: BACKGROUND
  Analysis of the prescribing patterns of antipsychotic drugs can improve therapeutic outcomes. The purpose of this study was to evaluate the prescribing pattern of antipsychotics and its conformance to international treatment guidelines.
  
  
  METHODS
  A cross sectional study at primary psychiatric centers was carried out. Patients' medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. All statistical analyses were conducted using Statistical Package for Social Sciences.
  
  
  RESULTS
  250 patients were included in this study. A total of 406 antipsychotic agents were used; 348 (85.7%) were first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n=126). There was no significant difference in positive (p=0.3), negative (p=0.06) and psychopathology (p=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose of (300 - 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Analysis showed that use of depot, use of anticholinergic agents and increasing amount of total CPZeq were significant factors associated with antipsychotic combination.
  
  
  CONCLUSIONS
  This study indicated that antipsychotic prescribing was not in conformance with international guidelines with respect to maintenance dose and combination therapy. Type of antipsychotic treatment regimen, combination versus monotherapy, was not associated with better clinical or economic outcome.
authors.affiliation: Division of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine. waleedsweileh@yahoo.com
authors.forename: Waleed M
authors.initials: WM
authors.lastname: Sweileh
authors.forename: Jihad Bani
authors.initials: JB
authors.lastname: Odeh
authors.forename: Sa'ed H
authors.initials: SH
authors.lastname: Zyoud
authors.forename: Ansam F
authors.initials: AF
authors.lastname: Sawalha
authors.forename: Manal S
authors.initials: MS
authors.lastname: Ihbeasheh
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents